Headaches – USMLE Exams
Migraine: 60% are unilateral, often triggered by: cheese, caffeine, menses, OCP’s
Do a CT or MRI if HA has any of the following:
- Sudden and/or severe
- Onset after 40yr
- Associated with any neurological findings
- May be preceeded by an aura and/or scotomata (Dark spots in visual field), and abnormal smells
- The best initial abortive therapy is sumatriptan or ergotamine
- Prophylactic therapy takes 4-6wks to work, if patient gets four or more HA per month, prophylax with propranolol.
- Alternate prophylactics with CCBs, TCA’s, or SSRI.
Cluster Headaches: 10x more frequent in men than women. Are exclusively unilateral w/ redness and tearing of the eye and rhinorrhea.
- The best abortive therapy is 100% 02.
- This treatment is unique to cluster HA’s.
- Sumatriptan can also be used in same way as is in migraines.
Prophylactic therapy: there is none because these HA’s are numerous but short and intense, and the “cluster” would be over by the time the prophylaxis kicked in.
|Gender||Men 10x more than women|
|Presentation||Unilateral or bilateral, aura||Only unilateral, tearing/redness of eye|
|Abortive||Sumatriptan||Sumatriptan, Special: 100%02|
* Sumatriptan is similar to 5HT, and works by causing vasoconstriction in cerebral arteries.
Patient will present with tenderness over the temporal area and may also complain of jaw claudication
- First check the ESR
- The most accurate test is a biopsy of the temporal artery
- Give steroids immediately, do not delay if this is suspected
- This presents most commonly in a younger woman with a headache and double vision, papilledema
- CT/MRI show up normal
- Vitamin A use is often the cause
- LP is the most accurate test because it shows an elevated opening pressure
- Involves weight loss
Acetazolamide can also be given